hi all
Just left the Endo. She said tsh is bit low, so let's half t4 dose one day a week, and continue on t3 5 mcg 2x a day.
I'm so surprised she did not say reduce the t3.
I am currently on 100 Levo and 10mg lio
What do you think bout the reducing Levo to 50 one day of the week?
I'm thinking of not doing this. Next bloodwork is in 3 mo.
Depends how you are feeling and what your blood test results are like ( including free T3 and free T4 too with ranges). Without this info nobody could know. If you don't have the results then I would ask for them.
sorry bout that I had previously posted the labs
Tsh 0.30 (0.40-4.50)
Ft3 3.2 ( 2.3-4.2)
Ft4 1.2 (0.8-1,8)
Taking 100 Levo and 10 lio
How did you take this test? What time of day was it? What was the time spacing for last dose of Levo & T3 before the test?
Recommended blood test protocol: Test at 9am (or as close as possible), fasting, last levo dose 24hrs before the blood draw, last T3 dose 8-12 hours before blood draw & no biotin containing supplements for 3-7 days (Biotin can interfere with thyroid blood results as it is used in the testing process).
Testing like this gives consistency in your results and will show stable blood levels of hormone and highest TSH which varies throughout the day. Taking Levo/T3 just prior to blood draw can show a falsely elevated result and your GP/Endo might change your dose incorrectly as a result.
Almost any amount of T3 will lower TSH by a lot, usually below range, if not suppressed.
Your TSH is only just below range and bcause you are taking T3 is actually too high.
FT4 is only 40% of range so really yo need to increase Levo.
FT3 only 47% of range but assessing this depends on timing of last dose of T3 before test.
My blood was taken 7:40 am, last t3 dose was 1 pm previous day. Last Levi was 5:30 am previous day.
So both are longer than the recommended timing showing false lows, FT3 being the longest spacing and false low.
Suggest for future tests to delay second T3 dose to allow 8-12hrs from blood test.
Timings of last dose of hormones is important so that comparisons can be made between blood tests and to capture stable blood levels.
Likely you need to raise Levo.
You can take responsibility for low TSH as per NICE guidelines:
The first paragraph in the NICE (NHS) Thyroid Disease, Assessment and Management guidelines says :
nice.org.uk/guidance/ng145
"Your responsibility”
The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian. “
I did allow 12 plus hours I dosed t3 at 1 pm on Friday blood was taken 7:40am Saturday. No biotin
It should be between 8 and 12 hours. Not 12hrs plus.
7.40pm or after would have been the latest to take T3 dose.
ok thank you so much. Is my Ft4 also falsely low?
Ok I will time the next test accurately. It's scheduled for Oct Don't know how I'm taking t3 12 hours prior? My labs are at 8:30 am how should I dose the day before? I usually take 100 Levothyroxine with 5 liothyronine at 5:30 am. Then I second dose the liothyronine 5 mcg at 1pm. Am I doing this wrong?
thank you so much for the info. I'm gonna def time the doses correctly going forward. Only thing I ever knew was to hold meds til after blood draw.
So for now, being my labs are falsely low, I should stay on the 100 Levothyroxine and 10 liothyronine til next test? I promise this is my last question!
The likelyhood is you need a little more of one of the hormones but as FT3 especially was false low its hard to tell which.
For a blood test at 8.30am take Levo at 8.30am the day before.
T3 would be taken between 8.30pm and 12.30am.
If your Endo is only looking at your TSH and you are taking T3 then likely they will keep you unwell. You might want to think about finding a different Endo.
yea I agree but finding an endo open to prescribing t3 is not easy . I live in NY, took me 20+ years to find a dr willing to test my ft3. Was taking only synthroid and the Dr insisted my tsh fall between 1-2. I had many hypo symptoms but he wouldn't listen. He also insisted I only take synthroid.
I really appreciate all your help.
Don’t you think it’s a bit odd? This doctor is bothering getting the T4 and T3 levels (both which appear to be low) and still appears to be dosing on TSH only.
Final points Jaydee1507 makes - When were the bloods taken AND what precautions had been taken about timing of medication. Extremely important!
AND AKatieD says too. Important to consider how you are feeling. It would be dreadful to disturb a ‘sweet spot’ for the sake of someone who can’t help but ‘meddle’.
I'm feeling much better since the second t3 5 mcg was added back in mid April, however still bit low motivation but better as I said.
yes I do think it's odd re her treating to my tsh level, but totally expected. Before I went yday I was contemplating asking if adding 5mcg more of lio could help bring my ft3 to upper range. Once she went on about reducing the Levothyroxine dose once a week I knew to shut up! Main goal was to get the 90 day supply of lio. So what do I do? Increase the t4 and if so by how much. I'm really not happy with the Drs plan.
So you are feeling much better. That’s great and worth holding on to. It’s ridiculous us being put in this position. Do you at least have enough Levo to not reduce your T4? I am absolutely no expert but I understand the timing of T3 meds are as you describe - so T3 level (for normal) testing for you is always going to be low. This is better for you if you think you need an increase in T3 (which you may be able to manage in said three months). Plus you look like you could perhaps use a possible increase in Levo. However I would not even guarantee that at this juncture.
Sounds to me (taking into consideration the above) you may be near your ‘sweet spot’. Unfortunately that’s not able to be pinpointed by tests. It’s yours and yours alone. I would be extremely reluctant to even minimally mess with your Levo at all at the moment (or T3). Do you feel you can give yourself another three months with no changes?
There are other posts recently on how to ‘extract’ more Levo from your prescriber, to allow you to continue on your present course and giving you a better view of your progress. E.g. loss of meds. Another 3 months might improve things just by staying on the the same dosages. There are definitely reports on the Forum of people finding a dosage from which they continue to improve - especially as you have noted “I’m feeling much better since the second T3 …”. I’d be very reluctant to lose that by messing about. Three months will pass before you know it and your judgement will be even clearer.
Not that you need to take this into consideration but if you can keep your endo/doctor onside, it’s less stressful.
Thank you for your reply. Yea I have enuf Levothyroxine to stay on the 100. The minute she told me to drop it to half one time/ week I was in my head saying ," that's not happening "!
I will stay on same med dosage and retest in October. Yes I have no intention of leaving this endo as like I said t3 prescribers are few n far between.
Good call, I think!
yeah I'll see how labs look in October. I feel I won this round tho. I was almost certain she was gonna say let's drop the t3 back to once a day. She ordered the meds and I got out of there quickly!
She knows I have a medical background so she seems a bit cautious when I do challenge her advice. The cutting one dose in half 1x a week Levothyroxine) was not worth an argument in my mind.
I'm also now able to reach out for the knowledge of this forum which I'm very grateful to have. I joined to discuss daughters thyroid journey but I myself need it too.
Thanks again
Lab tests:
Can anyone explain these results please?
HELP! BAD LAB RESULTS WITH NDT 
Blood results
Latest Lab Results.
